Tuesday, March 21, 2017

Overcoming Performance Anxiety and Panic Attacks

"I don't think you can help me, said Jack. "I've never told this to anybody at work, and I certainly don't want it to go any further than you, but I sometimes get panic attacks so bad I have to go to the emergency clinic."

"Great!" I said, to his puzzlement. "We have an opportunity to make a difference in your life that's so significant, you'll find everything else we do a piece of cake." Though we'd talked for almost two hours, this was our first meeting and I knew I was taking a chance to challenge Jack in this way, but he'd been responsive so far, and I thought he'd at least try what I suggested. "Raise up that feeling of panic right now," I said.

"Are you nuts?" he asked, with apparent rising panic.

"I promise you it won't get out of hand," I soothed. "Just think of the last time you felt panic and do the best you can to recapture the feelings. Where did you feel it in your body?" Using this paradoxical strategy, we worked with Jack's unconscious to undercut the assumption that he had no control over the panic attacks (if he could bring them on, they were within his control). Once he focused on the sensations associated with panic, I had him exaggerate them, assuring him all the time that to his surprise the symptoms would eventually diminish.

And they did. Not only that, but he was able to use the technique whenever the symptoms began to arise, and he never again had a full-blown panic attack.

This approach is "paradoxical" because you might logically expect that bringing the symptoms on would make them worse. The paradox: inviting the symptoms leads to their diminishment or even extinction.

There are a number of terrific resources available on this topic. I have a fondness for Dr. R. Reid Wilson, partly because panic is his particular area of expertise and partly because he has a great sense of humor. I first encountered Dr. Wilson at a brief therapy conference where he started his session with a Far Side cartoon showing a cut-away view of two moles below ground. One of them was shaking and perspiring profusely, saying to the other mole, "It's O.K.! It's O.K.! The tunnel was closing in on me there for a while, but I'm all right now!"

In Don't Panic, Wilson writes:
Our instinctual defenses fail to overcome panic. In fact, they actually support the recurrence of anxiety attacks. We encourage and strengthen the power of panic by treating it as our "enemy," to be avoided or to be battled . . . Whenever you resist something, that something will persist.
He suggests the following ways to cooperate with symptoms instead of competing with them:
  • Take a calming breath and begin natural breathing.
  • Don't fight the symptoms or run away.
  • Consciously decide to use a paradoxical strategy.
  • Observe your most predominant physical symptom at this moment.
  • Say "I wold like to increase____"
  • Consciously increase the predominant symptom.
  • Now increase all other symptoms you notice.
  • Continue natural breathing while consciously increasing symptoms.
  • Don't get trapped in worried, critical, or hopeless comments.
Deeper work may be needed to address the issues behind the symptoms, but this is much easier once you're relieved of focusing on the symptoms. According to Wilson, "Panic says, 'Wake up! You're not facing something!"

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